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SUGGESTIONS FOR AN IMPROVED MODE OF VENTILATION.
no inflammatory areola; usually makes its first appearbetween the fifth and tenth day, never after the twentieth; generally long survives ulceration. Induration varies in degree somewhat with the situation; but, when slight, is nevertheless always defined. Pat3coZoryical Tendencies.-The secretion is scanty, rather serous than purulent, and is not very readily inoculated; hence the sore is usually single, rarely multiple, and if so the sores .appear simultaneously. It is indolent, but less so perhaps than the soft chancre; rarely takes on phagedsena. Either sore propagates by inoculation, invariably produces its like. Clzaracteristic Gland Affection.-It is 1:nvariably followed by slight swelling and marked induration of the inguinal glands on one or both sides (the sore being on the genital organs); usually several glands are affected; they are hard, incompressible and roll under the finger, are painless, and do not inflame or suppurate; except, in rare instances, from over exertion, in scrofulous subjects, &c., but then the pus is not specific and not inoculable. The induration of the gland coincides in time with that of the chancre itself. The primary sore having disappeared, or being denied, the gland-induration is an invaluable sign for purposes of diagnosis. Prognosis.-Constitutional syphilis will certainly declare itself sooner or later. Mercury will retard, modify, or prevent the evolution of secondary symptoms. A highly interesting discussion followed, in which several members took part. Many cases were related from the experience of the speakers, confirmatory of the truth of Mr. Thorapson’s statements. Dr. HEADLAM GREENHOW, who had had charge of a military hospital, and had there seen much syphilis, did not recollect ever to have seen a sore accompanied by open buboes, followed
them; ance
ecchymosis spread, and no pulsation could be detected in the popliteal or posterior tibial arteries. He became delirious, and died. Upon the examination after death, the ecchymosis was found to extend from Poupart’s ligament above to the ankles below. All the tissues were infiltrated with blood, and masses of clotted blood were found between the muscles extending into the abdomen; the gracilis and other muscles were ruptured and infiltrated with blood. Just at the point where the femoral artery passes through the tendon of the adductor muscles a hole was detected in the artery, and around the opening pieces of the fibrous structure of its coat were seen. The coats of the artery were extensively diseased, being atheromatous up to the giving off of the profunda and above. The opening was considered as the result of ulceration, and under the microscope ossific plates and atheromatous deposits were seen imbedded in the walls of the vessel. Mr. MARTYN then detailed the particulars of a case of the
CROUP.
The child, aged three years and a half, first gave symptoms of croup on March 17th; they were, however, unrecognised as such until March 22nd, when Mr. Martyn first saw her. They were very decided then, and called for active treatment by The next day, the child was relieved, calomel, antimony, &c. but the medicines ordered to be continued. On the 27tb, the croupy symptoms, which had mended up to that time, recurred ; and, on the 28th, by the advice of Dr. Hastings, leeches were applied to the larynx. The leech bites, however, bled too freely, and the child became blanched and exhausted, and the next day required the use of opiates, and the free administration of stimulants. The child, however, never rallied, but died on the 5th of the next month, being twenty-one days from the commencement of the attack. There was no postby secondary symptoms. mortem examination. The case was interesting on account of Mr. BALLARD spoke to the same effect. Mr. WEEDEN CooxE was inclined to doubt the universality the length of the duration of the symptoms before death, the of Mr. Thompson’s laws as laid down. He considered that in croup in this case probably killing by the disease extending down the trachea into the larger bronchial tubes, and so women soft chancres are frequently followed by secondary affections. Again, he had seen a case of indurated chancre, in obstructing the breathing. which no secondary symptoms followed, although uo treatment 0 had been adopted. Dr. CAMPS objected to the author’s views, that, if true, they would necessitate the admission of the existence of two different forms of syphilis, which he could not allow. Mr. CLEVELAND cited an interesting case of indurated chancre, i I’ Audi alteram partem." in which mercury was ineffectual in checking the phagedeenio ulceration which followed. SUGGESTIONS FOR AN IMPROVED MODE OF Mr. ROBINSON had found the syrup of the iodide of iron a very VENTILATION. valuable medicine for syphilis in children. Dr. HANDFIELD JONES, Mr. LANGMORE, and Dr. PANTON also [LETTER FROM SIR JAMES MURRAY, M.D.] participated in the discussion. To the Editor of THE LANCET. Mr. THOMPSON, in reply, stated that he thought the day was not far distant when we should speak of chancre and chancroid STR,-During this Thames panic, perhaps some M.P. may to distinguish the two forms alluded to. He would only be reflect in earnest that chemistry and machinery have effected disposed to allow the existence of one syphilis, although there many wonders, and can still accomplish more: they can cerwere two kinds of venereal sores. In cases where soft chancres tainly furnish means to reverse the common methods of ventiwere said to be followed by secondary symptoms, he would by adopting aeriform traction instead of repulsion. dispute the correctness of the diagnosis. The sore had at one lation, To copy, in some degree, the material operations of the lungs been The state afforded the indurated. diagnostic by period and heart, may afford better means of leading away offensive state of the glands he regarded as of great importance. gases, smells, and miasms, than by driving them off by blowing. The usual modes of renewing the air in buildings, chanWESTERN MEDICAL AND SURGICAL SOCIETY. nels, and institutions, only disturbs-commingles bad air with good. But by imitating the mechanism of respiration, and WM. MARTYN, ESQ., V.P., IN THE CHAIR. securing exhalation, first, from chambers or cavities, they will instantly be filled by inspiration of good air, to replace, by MR. LEGGATT read the report of a case of volumes, the foul vapours withdrawn. equal SPONTANEOUS RUPTURE OF THE FEMORAL ARTERY. A capacious tunnel, or long reach of a cemented drain, ten ’The patient, a man aged seventy-three, had been subject to or twelve feet deep from roof to floor or invert, serves the purgout for the last forty years, and had passed albumen in his pose. The line of level of the invert descends by three steps, urine for a long period, though of late it had ceased entirely. of ten or twelve inches deep, to serve for a rapid current of In the last four or five years before his death he had had giddi- sewage, by gravitation, and to present the riser of each step as ness, and been attacked with symptoms of angina pectoris with a lip or stay for valves to press against, that the stream may syncope; he had also complained of numbness of the lower ex- flow to the exit, tank, well, or outfall, in one direction only. tremities, with pains, and had become less active. On the A second floor of slates, or the like, divides the tunnel longi13th of March, 1858, he had an attack of syncope, and pain at tudinally into two stories. Three valves depending from the the top of the right thigh, which was unattended with swelling arch or upper floor, separate the long ranges into three or or tenderness. The urine was loaded with albumen, and he four chambers. On the platforms between each valve, several On the 14th swellingand perches long, beds of filtering materials are spread in framesfainted twice in goingto bed. oedema supervened to the pain in the thigh, the swelling gravel in the first area, sand in the second, charcoal and peat assuming a brawny appearance towards night. On the 15th mould in the third, and magnesian limestone with broken coke ecchymosis occurred over the upper part of the rectus muscle, in the fourth floor, for percolation, to clear the slush and corand pulsation was perceptible in the swelling. On the 17th rect putrid smells, &c.
Correspondence.
20
, W11.’ilst. the drainage percolates through these porous filters, English mode of legislating. The implied word of the ruling its offensive gases ascend by an opening into the first space bodies should be as honourably kept with the tyro articled the of the second story. This part of the gallery is ranged with day before the new regulations passed as with the ripest thirdcrates of fresh dry lime, slaked, and mixed with broken coke, year’s man ready to " go up’’ to-morrow. to abstract the carbonic acid and sulphuretted impurities from If the new rules had been made to act prospectively, allowthe gases, smoke, breath, and animal effluvia. ing it to be optional with all in the profession at present to The gases are drawn along, by the operations of rarefaction, pass either the old or new examination, almost to a man the through loose shelves, cages, and nets of porous powders, coke, students would have voluntarily chosen to pass the new one, &c., moistened with muriatic acid, to detain ammonia, and to and the corporations would haveretained respect and conpurify the air, as it did long since in the Cathedral of Dijon, fidence in their good faith; whilst their retrospective enactwhen abandoned to malaria. ments will do much to shake the full confidence previously Through the other reaches of this long gallery the gases are reposed in them as the ruling representatives of the profession. drawn through magnesian and carbonaceous shelves of powders, I am, Sir, yours most respectfully, to mask and abate putrid efnavia and to form triple salts. CHESELDEN. St. Thomas’s Hospital, Jtme, 1858. Whilst the liquid race descends through refining sieves along the under rloor, the aeriform fumes traverse the dry, powdery, REMARKS ON VACCINATION, AND ITS CAUSES sifting purifiers, through which the gases are drawn to traction end of the arch or tunnel. OF FAILURE. The reason why deodorizing has always failed is this: that To the Editor of THE LANCET. the witches treated the fluids, solids, and gases all in the same cauldron, and that there never has been established any effecthe SIR,-.As subject of vaccination is one in which the tual means of drawing the offensive gaseous atmospheres are very much interested at this present time, I take public through a proper series of separate edulcorators, each fit to leave to offer a few remarks upon it. separate and fix, in silt or sediment, the particular obnoxious Having practised vaccination for upwards of fifty years, I quality to which the antidote is alone adapted. have great pleasure in giving testimony to its efficacy as a preAs a very moderate rarefaction suffices to raise the guage to I ventative against small-pox when properly carried out. a pound or two on the inch, the exhausting means are numerous therefore, briefly endeavour to point out the causes which, and economical. Where there are no long valves or leakage, shall, in my opinion, have brought vaccination into disrepute. In the and the motive power is little, an engine like that of the atmo- first place, the prejudice of the public is very much against it ; spheric railway would effect the traction of many square miles and secondly, the careless and slovenly manner in which it is. of offensive gases daily, and send them, decomposed, scentless, in consequence of the medical men not being suffiperformed, and colourless, up the steam funnel, and in other localities up remunerated for their trouble, (which is something very lighted lamps* and spouts of houses, connected below the ciently If it is to’ more especially in the rural districts. considerable,) chimney tops.* be carried out successfully, it must be by the energy and perseI am, Sir, yours &c.. verance of medical practitioners, which can only be obtained by J. MURRAY, M.D. June, 1858. rewarding them liberally for tried services. It is a very comN.B. Where hospitals, barracks, towns, or cities require mon case that, the child having been vaccinated, the parents modifications of these principles on a large scale, duplicate themselves little or no trouble about it, more especially if give tunnels and tanks are best adapted, to clear out soot, silt, and there happens to be a pustule or vesicle of some kind. When guano from one, whilst the other is in operation. vaccination was first introduced there was much more attention paid to it than there has been of late years. At that time it was customary for the medical men to visit their little patients THE NEW COLLEGE REGULATIONS. several times after vaccination, and carefully watch the proTo the Editor of THE LANCET. gress of the vesicle, and see that it passed through its various stages, so accurately described by the late Dr. Jenner. I ask for a few the insertion in of SIR,-May your journal I believe it is from want of that attention lines having reference to the new regulations of the College of that conscientiously so many cases of failure have lately occurred. A spurious Surgeons disease may here have been introduced, and propagated from number of medical students to far the propose By greater one to another. I conceive it is almost impossible that a mebecome general practitionersthe remaining few aspire to the dical who visits his patient only once on the seventh or man, heights of learning, and desire a scholastic as well as pro- eighth day after vaccination, can pronounce whether the disease fessional reputation. The former, having obtained the College is or is not genuine cow-pox. Again, I haveoften thought and Hall diplomas, apply themselves, with more or less that the vesicle being broken or otherwise destroyed is not undiligence, to their life-work, and are far more anxious to gain frequently a cause of failure, by preventing the virus from a reputation for practical skill than for polished erudition. To broken up into the system, without which there can be be masterly in amputations, unerring in fractures and disloca- being no security against the contagion of small-pox. If, as fretions, sure in medical practice, and thorough adepts in difficult quently there is only one vesicle, and that happens ta happens, obstetricy, is their mark. None but their own order know be broken or destroyed, the patient ought to be re-vaccinated. how arduous is the task; but, if only partially achieved, how I have always thought it the safest way to vaccinate on both great! if completely so, how glorious ! Such is the class of arms, and if there is occasion to take matter to leave one of men who have presented themselves for examination at the the vesicles entire ; and in these cases where there is only one Hall and College, and at both places the questions have been vesicle, and the practitioner is compelled to take matter, the confined to the essentials of professional knowledge. to be re-vaccinated on the opposite arm at the The spirit of progress required, in order to advance thestatus patient ought time of taking the matter. My opinion is, that if the foregoing of the general practitioners of this country, that the examina- rule were strictly carried out, we should very seldom hear of tions, though still retaining their character as a test for prac- cases of small-pox after vaccination, and thus the confidence of tical ability, should become more strict and searching, and that the would be obtained. public there should be less latitude extended than at present to the I am, Sir, yours, &c., indolent and the incompetent. J. DAVIES, M.D. Coleshill, June, 1358. J. One somehow feels thankful for the smallest efforts that the Hall and College make to comply with the spirit for improveASSUMPTION OF MEDICAL TITLES. ment so characteristic of the age. Possibly this feeling arises from the extreme rarity of their efforts in this direction; they To the Editor of THE LANCET. indeed cling fondly to the past-they lack faith in the future. SIR, - In compliance with the accompanying resolution, The new regulations are generally approved of by those to be addition to the concerned with little likely them, present passed at a meeting of the Nottingham Medico-Chirurgical curriculum being necessary to obtain the diplomas, the posses- Society, I beg to forward you the enclosed statement and corsion of which will be attended with additional honour. The respondence. satisfaction, however, which the new regulations give is mixed I am, Sir, your obedient servant, to act dissatisfaction at their made with great being retrospecE. CHAS. BUCKOLL, Hon. Sec. Nottingham Soe. tively. I believe it is the feeling of most of the London Nottingham Med.-Chir. Soc. Dispensary, Nottingham, June 23rd, 1858. students that this precedent is most dangerous and objectionable. They consider it repugnant to English honesty and the " *See Notos on Resolved—That the secretarv of this Societv be reauested Cholera, 1848.
(I
theI
DAVIES,
21
them; ance
ecchymosis spread, and no pulsation could be detected in the popliteal or posterior tibial arteries. He became delirious, and died. Upon the examination after death, the ecchymosis was found to extend from Poupart’s ligament above to the ankles below. All the tissues were infiltrated with blood, and masses of clotted blood were found between the muscles extending into the abdomen; the gracilis and other muscles were ruptured and infiltrated with blood. Just at the point where the femoral artery passes through the tendon of the adductor muscles a hole was detected in the artery, and around the opening pieces of the fibrous structure of its coat were seen. The coats of the artery were extensively diseased, being atheromatous up to the giving off of the profunda and above. The opening was considered as the result of ulceration, and under the microscope ossific plates and atheromatous deposits were seen imbedded in the walls of the vessel. Mr. MARTYN then detailed the particulars of a case of the
CROUP.
The child, aged three years and a half, first gave symptoms of croup on March 17th; they were, however, unrecognised as such until March 22nd, when Mr. Martyn first saw her. They were very decided then, and called for active treatment by The next day, the child was relieved, calomel, antimony, &c. but the medicines ordered to be continued. On the 27tb, the croupy symptoms, which had mended up to that time, recurred ; and, on the 28th, by the advice of Dr. Hastings, leeches were applied to the larynx. The leech bites, however, bled too freely, and the child became blanched and exhausted, and the next day required the use of opiates, and the free administration of stimulants. The child, however, never rallied, but died on the 5th of the next month, being twenty-one days from the commencement of the attack. There was no postby secondary symptoms. mortem examination. The case was interesting on account of Mr. BALLARD spoke to the same effect. Mr. WEEDEN CooxE was inclined to doubt the universality the length of the duration of the symptoms before death, the of Mr. Thompson’s laws as laid down. He considered that in croup in this case probably killing by the disease extending down the trachea into the larger bronchial tubes, and so women soft chancres are frequently followed by secondary affections. Again, he had seen a case of indurated chancre, in obstructing the breathing. which no secondary symptoms followed, although uo treatment 0 had been adopted. Dr. CAMPS objected to the author’s views, that, if true, they would necessitate the admission of the existence of two different forms of syphilis, which he could not allow. Mr. CLEVELAND cited an interesting case of indurated chancre, i I’ Audi alteram partem." in which mercury was ineffectual in checking the phagedeenio ulceration which followed. SUGGESTIONS FOR AN IMPROVED MODE OF Mr. ROBINSON had found the syrup of the iodide of iron a very VENTILATION. valuable medicine for syphilis in children. Dr. HANDFIELD JONES, Mr. LANGMORE, and Dr. PANTON also [LETTER FROM SIR JAMES MURRAY, M.D.] participated in the discussion. To the Editor of THE LANCET. Mr. THOMPSON, in reply, stated that he thought the day was not far distant when we should speak of chancre and chancroid STR,-During this Thames panic, perhaps some M.P. may to distinguish the two forms alluded to. He would only be reflect in earnest that chemistry and machinery have effected disposed to allow the existence of one syphilis, although there many wonders, and can still accomplish more: they can cerwere two kinds of venereal sores. In cases where soft chancres tainly furnish means to reverse the common methods of ventiwere said to be followed by secondary symptoms, he would by adopting aeriform traction instead of repulsion. dispute the correctness of the diagnosis. The sore had at one lation, To copy, in some degree, the material operations of the lungs been The state afforded the indurated. diagnostic by period and heart, may afford better means of leading away offensive state of the glands he regarded as of great importance. gases, smells, and miasms, than by driving them off by blowing. The usual modes of renewing the air in buildings, chanWESTERN MEDICAL AND SURGICAL SOCIETY. nels, and institutions, only disturbs-commingles bad air with good. But by imitating the mechanism of respiration, and WM. MARTYN, ESQ., V.P., IN THE CHAIR. securing exhalation, first, from chambers or cavities, they will instantly be filled by inspiration of good air, to replace, by MR. LEGGATT read the report of a case of volumes, the foul vapours withdrawn. equal SPONTANEOUS RUPTURE OF THE FEMORAL ARTERY. A capacious tunnel, or long reach of a cemented drain, ten ’The patient, a man aged seventy-three, had been subject to or twelve feet deep from roof to floor or invert, serves the purgout for the last forty years, and had passed albumen in his pose. The line of level of the invert descends by three steps, urine for a long period, though of late it had ceased entirely. of ten or twelve inches deep, to serve for a rapid current of In the last four or five years before his death he had had giddi- sewage, by gravitation, and to present the riser of each step as ness, and been attacked with symptoms of angina pectoris with a lip or stay for valves to press against, that the stream may syncope; he had also complained of numbness of the lower ex- flow to the exit, tank, well, or outfall, in one direction only. tremities, with pains, and had become less active. On the A second floor of slates, or the like, divides the tunnel longi13th of March, 1858, he had an attack of syncope, and pain at tudinally into two stories. Three valves depending from the the top of the right thigh, which was unattended with swelling arch or upper floor, separate the long ranges into three or or tenderness. The urine was loaded with albumen, and he four chambers. On the platforms between each valve, several On the 14th swellingand perches long, beds of filtering materials are spread in framesfainted twice in goingto bed. oedema supervened to the pain in the thigh, the swelling gravel in the first area, sand in the second, charcoal and peat assuming a brawny appearance towards night. On the 15th mould in the third, and magnesian limestone with broken coke ecchymosis occurred over the upper part of the rectus muscle, in the fourth floor, for percolation, to clear the slush and corand pulsation was perceptible in the swelling. On the 17th rect putrid smells, &c.
Correspondence.
20
, W11.’ilst. the drainage percolates through these porous filters, English mode of legislating. The implied word of the ruling its offensive gases ascend by an opening into the first space bodies should be as honourably kept with the tyro articled the of the second story. This part of the gallery is ranged with day before the new regulations passed as with the ripest thirdcrates of fresh dry lime, slaked, and mixed with broken coke, year’s man ready to " go up’’ to-morrow. to abstract the carbonic acid and sulphuretted impurities from If the new rules had been made to act prospectively, allowthe gases, smoke, breath, and animal effluvia. ing it to be optional with all in the profession at present to The gases are drawn along, by the operations of rarefaction, pass either the old or new examination, almost to a man the through loose shelves, cages, and nets of porous powders, coke, students would have voluntarily chosen to pass the new one, &c., moistened with muriatic acid, to detain ammonia, and to and the corporations would haveretained respect and conpurify the air, as it did long since in the Cathedral of Dijon, fidence in their good faith; whilst their retrospective enactwhen abandoned to malaria. ments will do much to shake the full confidence previously Through the other reaches of this long gallery the gases are reposed in them as the ruling representatives of the profession. drawn through magnesian and carbonaceous shelves of powders, I am, Sir, yours most respectfully, to mask and abate putrid efnavia and to form triple salts. CHESELDEN. St. Thomas’s Hospital, Jtme, 1858. Whilst the liquid race descends through refining sieves along the under rloor, the aeriform fumes traverse the dry, powdery, REMARKS ON VACCINATION, AND ITS CAUSES sifting purifiers, through which the gases are drawn to traction end of the arch or tunnel. OF FAILURE. The reason why deodorizing has always failed is this: that To the Editor of THE LANCET. the witches treated the fluids, solids, and gases all in the same cauldron, and that there never has been established any effecthe SIR,-.As subject of vaccination is one in which the tual means of drawing the offensive gaseous atmospheres are very much interested at this present time, I take public through a proper series of separate edulcorators, each fit to leave to offer a few remarks upon it. separate and fix, in silt or sediment, the particular obnoxious Having practised vaccination for upwards of fifty years, I quality to which the antidote is alone adapted. have great pleasure in giving testimony to its efficacy as a preAs a very moderate rarefaction suffices to raise the guage to I ventative against small-pox when properly carried out. a pound or two on the inch, the exhausting means are numerous therefore, briefly endeavour to point out the causes which, and economical. Where there are no long valves or leakage, shall, in my opinion, have brought vaccination into disrepute. In the and the motive power is little, an engine like that of the atmo- first place, the prejudice of the public is very much against it ; spheric railway would effect the traction of many square miles and secondly, the careless and slovenly manner in which it is. of offensive gases daily, and send them, decomposed, scentless, in consequence of the medical men not being suffiperformed, and colourless, up the steam funnel, and in other localities up remunerated for their trouble, (which is something very lighted lamps* and spouts of houses, connected below the ciently If it is to’ more especially in the rural districts. considerable,) chimney tops.* be carried out successfully, it must be by the energy and perseI am, Sir, yours &c.. verance of medical practitioners, which can only be obtained by J. MURRAY, M.D. June, 1858. rewarding them liberally for tried services. It is a very comN.B. Where hospitals, barracks, towns, or cities require mon case that, the child having been vaccinated, the parents modifications of these principles on a large scale, duplicate themselves little or no trouble about it, more especially if give tunnels and tanks are best adapted, to clear out soot, silt, and there happens to be a pustule or vesicle of some kind. When guano from one, whilst the other is in operation. vaccination was first introduced there was much more attention paid to it than there has been of late years. At that time it was customary for the medical men to visit their little patients THE NEW COLLEGE REGULATIONS. several times after vaccination, and carefully watch the proTo the Editor of THE LANCET. gress of the vesicle, and see that it passed through its various stages, so accurately described by the late Dr. Jenner. I ask for a few the insertion in of SIR,-May your journal I believe it is from want of that attention lines having reference to the new regulations of the College of that conscientiously so many cases of failure have lately occurred. A spurious Surgeons disease may here have been introduced, and propagated from number of medical students to far the propose By greater one to another. I conceive it is almost impossible that a mebecome general practitionersthe remaining few aspire to the dical who visits his patient only once on the seventh or man, heights of learning, and desire a scholastic as well as pro- eighth day after vaccination, can pronounce whether the disease fessional reputation. The former, having obtained the College is or is not genuine cow-pox. Again, I haveoften thought and Hall diplomas, apply themselves, with more or less that the vesicle being broken or otherwise destroyed is not undiligence, to their life-work, and are far more anxious to gain frequently a cause of failure, by preventing the virus from a reputation for practical skill than for polished erudition. To broken up into the system, without which there can be be masterly in amputations, unerring in fractures and disloca- being no security against the contagion of small-pox. If, as fretions, sure in medical practice, and thorough adepts in difficult quently there is only one vesicle, and that happens ta happens, obstetricy, is their mark. None but their own order know be broken or destroyed, the patient ought to be re-vaccinated. how arduous is the task; but, if only partially achieved, how I have always thought it the safest way to vaccinate on both great! if completely so, how glorious ! Such is the class of arms, and if there is occasion to take matter to leave one of men who have presented themselves for examination at the the vesicles entire ; and in these cases where there is only one Hall and College, and at both places the questions have been vesicle, and the practitioner is compelled to take matter, the confined to the essentials of professional knowledge. to be re-vaccinated on the opposite arm at the The spirit of progress required, in order to advance thestatus patient ought time of taking the matter. My opinion is, that if the foregoing of the general practitioners of this country, that the examina- rule were strictly carried out, we should very seldom hear of tions, though still retaining their character as a test for prac- cases of small-pox after vaccination, and thus the confidence of tical ability, should become more strict and searching, and that the would be obtained. public there should be less latitude extended than at present to the I am, Sir, yours, &c., indolent and the incompetent. J. DAVIES, M.D. Coleshill, June, 1358. J. One somehow feels thankful for the smallest efforts that the Hall and College make to comply with the spirit for improveASSUMPTION OF MEDICAL TITLES. ment so characteristic of the age. Possibly this feeling arises from the extreme rarity of their efforts in this direction; they To the Editor of THE LANCET. indeed cling fondly to the past-they lack faith in the future. SIR, - In compliance with the accompanying resolution, The new regulations are generally approved of by those to be addition to the concerned with little likely them, present passed at a meeting of the Nottingham Medico-Chirurgical curriculum being necessary to obtain the diplomas, the posses- Society, I beg to forward you the enclosed statement and corsion of which will be attended with additional honour. The respondence. satisfaction, however, which the new regulations give is mixed I am, Sir, your obedient servant, to act dissatisfaction at their made with great being retrospecE. CHAS. BUCKOLL, Hon. Sec. Nottingham Soe. tively. I believe it is the feeling of most of the London Nottingham Med.-Chir. Soc. Dispensary, Nottingham, June 23rd, 1858. students that this precedent is most dangerous and objectionable. They consider it repugnant to English honesty and the " *See Notos on Resolved—That the secretarv of this Societv be reauested Cholera, 1848.
(I
theI
DAVIES,
21